Trend of Electronic Cigarettes Papers - A Concise Analytical Review-Juniper publishers
JUNIPER PUBLISHERS-OPEN ACCESS INTERNATIONAL JOURNAL OF PULMONARY & RESPIRATORY SCIENCES
Abstract
Background and objectives: The use
of electronic cigarette is rapidly increasing and its safety and
efficacy remain a matter of debate. This study aimed to review relevant
articles to draw a conclusion regarding the trend of electronic
cigarettes papers and its massages.
Methods: All articles published in
PubMed-indexed journals until 2015 regarding electronic cigarette were
collected. Based on the results, they were registered in a checklist
under four categories of content, effects, consumption and others
according to their publication date.
Results: A total of 222 articles
were chosen for final review. The frequency of articles published in
years 2009 to 2015 was 1, 3, 5, 14, 33, 81 and 85, respectively. The
frequency of articles categorized under effects, consumption, content
and others was 101, 60, 38 and 23, respectively. Number of studies
reporting positive effects compared to those reporting adverse or no
effects was zero, zero, zero, 1 out of 3, 4 out of 15, 19 out of 50 and
19 out of 39 during the years 2009 to 2015, respectively.
Conclusion: Although, number of
studies supporting its use had increased in the recent years but,
further studies are warranted to ensure their safety and efficacy.
Introduction
Offering help to quit tobacco use and providing
smoking cessation services is one of the six measures of the MPOWER
policy package introduced by the World Health Organization (WHO) to
control tobacco epidemics in countries that signed the WHO Framework
Convention on Tobacco Control (FCTC). These services should be
up-to-date, easily accessible and affordable and must be preferably
provided by the health care system [1]. A wide range of smoking
cessation methods are now available including pharmaceutical therapy by
use of nicotine replacements such as Zyban (bupropion) and Chantix
(varenicline) medications and non-pharmaceutical methods such as
cognitive-behavioral therapy, instruction and training, personal
quitting plans, acupuncture, hypnotism, group therapy and
self-instruction. The above-mentioned methods and medications are
first-line strategies based on scientific evidence [2].
Electronic Nicotine Delivery System (ENDS) was
recently introduced to the market, which consists of a plastic or metal
mouthpiece, a liquid nicotine reservoir, a battery and an electronic
vapor producer. The user puffs on the mouthpiece and inhales a vapor
mixture of different chemicals including nicotine, followed by an exhale
[3]. This device was first designed for use in public places where
smoking is prohibited by law and was later recommended as a solution for
quitting or cutting down smoking and even as a low-harm cigarette for
smokers’ companions. By a significant rise in its use, 460 different
types of ENDS were manufactured and marketed [4,5]. However, evidence
exists regarding its adverse health effects [6,7]; the adverse health
consequences related to inhalation of its second hand smoke have also
been documented [8,9].
Following the manufacturers’ claims regarding
electronic cigarette helping smoking cessation, several studies
indicated its lack of success in helping smokers quit smoking [10,11].
Conversely, a few studies have reported short-term beneficial effects of
this device in decreasing the harmful effects of actual cigarette
smoking [12,13]. Despite the existing controversies regarding the
effects of ENDS, no consensus has been reached about its use. Despite
receiving no support or approval from the scientific organizations
worldwide such as the European Respiratory Society, American Respiratory
Society or the WHO (3), it is still extensively advertised by the media
and its use is increasing especially among the young adults and
non-smokers [14].
This study aimed to do a review on scientific articles
published to reach the trend of electronic cigarette papers and
its massages for having a simple conclusion regarding it.

This cross-sectional study was conducted in late 2014.
The PubMed database was searched for articles on electronic
cigarettes published until 2014 using the keywords “electronic
cigarette”, “power-driven cigarette”, e-cigarette”, “ENDS” and
“Electronic Nicotine Delivery System”. Flow Figure 1 shows
the process of article selection (retrieval, review, inclusion and
exclusion criteria).
A checklist was designed by a panel of experts, which included
date of publication, number of articles, number of accessible
articles and the results of studies. The retrieved articles were
coded and reviewed by two researchers separately under the
supervision of the research supervisor. The researchers filled
out the checklist. In case of disagreement between the two,
the research supervisor reviewed the article and filled out the
checklist.
In order to initially check reliability, a pilot inter-rater
reliability assessment was conducted. Each reviewer assessed
three randomly selected articles. The inter-rater reliability
was 76% before discussion; any discrepancies in answers
were discussed and a consensus was achieved on subsequent
review. After the training and pilot assessment, the researchers
were ready to do the literature search. The first report of the
researchers was observed again by the principal investigator,
who determined when the assistants were ready to work alone.
Eventually, 10% of all articles were randomly chosen
for final review. Based on the type of study and its results,
the studies were categorized under four groups of contents
(shape and compositions), effects (complications and smoking
cessation), consumption (prevalence and belief) and others
(laws and regulations, sales and marketing) taking into account
the publication date of studies.
Results


A total of 343 articles were retrieved; out of which, 29 (10%)
did not even have an accessible abstract. Of the remaining
274, 52 (19%) were not exclusively about electronic cigarette
and had only briefly mentioned it; thus, they did not meet our
inclusion criteria and were therefore excluded. Eventually, 222
articles (73.2% of the total) were chosen for final review, which
were categorized into four groups presented in Table 1 and
Figure 2 based on their publication date. Articles on the effects
of electronic cigarette had the highest frequency and mainly
reported the side effects of smoking cessation (n=101, 45.4%).
Articles on sales and marketing conditions and related laws
and regulations had the lowest frequency (n=23, 10.4%). None of the articles on the consumption rate made any comparison
or mentioned anything about the reduction of use. Among
articles on the effects of electronic cigarettes, number of studies
reporting positive effects compared to those reporting adverse
or no effects was zero, zero, zero, 1 out of 3, 4 out of 15, 19 out of
50 and 19 out of 39 during the years 2009 to 2015, respectively.
Discussion
Number of studies on electronic cigarettes has noticeably
increased in the recent years, which highlights the importance
of this topic in health programs and concerns regarding its
positive and negative health effects. Such a rise in popularity
may also be attributed to extensive advertisements of this
device in the media. However, Heydari, et al. [15] reported that
this device was not a valuable tool for smoking cessation based
on the number of studies on this topic. Another issue worthy of
noting is the increasing prevalence of electronic cigarette use
among the general population and particularly the young adults
[16,17]. No study was found reporting a reduction in use of
electronic cigarettes; this finding indicates the significant effect
of advertisements in the media on increasing the public demand
for this device regardless of its positive/negative health effects.
Some studies have pointed to the interest of young adults in
electronic cigarette since they truly believe that it is harmless and
think of it as a safe alternative to actual cigarettes [18,19]. In the
United Kingdom, electronic cigarette has been used for smoking
cessation and has proven to be desirable even for non-smokers
[20]. Electronic cigarette has also caught the attention of tobacco
companies, and the British-American tobacco (BAT) company
has referred to it as a giant investment [21]. For this reason,
number of studies on the sales and marketing of electronic
cigarettes has also increased in the recent years and many of
which, have pointed to the popularity of electronic cigarette
and the need for setting rules and regulations regarding its use
[22,23]. However, studies on the use of this device for smoking
cessation purposes have not reported promising results and
clinicians do not recommend it as an effective method to help
quit smoking [24].
Another noteworthy issue in assessment of the results
of studies was an inversion in the ratio of studies rejecting
electronic cigarettes to those supporting it in the recent years
as in 2014, 38% of articles and in 2015, 48% of articles reported
the electronic cigarettes to be effective. One reason may be that
its beneficial effects are revealing. However, the WHO has yet to
acknowledge the beneficial effects of electronic cigarette based
on documentation and evidence [1-3]. Apparently, the WHO
still needs time to reach a conclusion regarding the efficacy and
safety of electronic cigarettes.
Conclusion
Despite the existing evidence regarding the inefficacy of
electronic cigarettes, number of studies supporting its use has
increased in the recent years. However, electronic cigarette is
not yet recommended by the accredited health organizations
worldwide and therefore, further studies are still required to
scrutinize the safety and efficacy of this device.
Contribution
GH had the original idea, designed the study and outlined
the first draft of the manuscript. FC and LF read and approved
the final manuscript.
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